1. Nurse Prescribing John Carson Lead Nurse Lanarkshire Heart Failure Service

2. Changes May 2006 Following the discontinuation of the Nurse Prescribers' Extended Formulary on 30 April 2006, Nurse Independent Prescribers (formerly known as Extended Formulary Nurse Prescribers) are now able to prescribe any licensed medicine for any medical condition, including some Controlled Drugs

3. Benefits to patients Service delivery closer to home Reduces clinic/surgery visits Individualised care Promotes EBP Effective therapy delivered promptly Improves communication between prescriber and pharmacy Improves compliance

4. NMC requirements for prescribers successfully completed a Nursing and Midwifery Council (NMC) approved programme of preparation have their prescribing status entered onto the NMC register be employed by a NHS Trust and have access to a prescribing budget be currently working in a designated prescribing post

5. Training and educational aspects Allocated funding via Scottish Exec Courses must be recognised by NHS Education for Scotland (NES) Nurse must be nominated by manager Flexible course format Intensive course (broad subject areas) Requires commitment / support from medical team

6. Benefits to prescriber Allows greater autonomy Nurtures patient relationship Improves time management Promotes sense of accountability Encourages self- development Facilitates service development

7. Role of the Trust Clarity for implementation Provide a framework which supports the prescriber Provide a framework that ensures patient safety Clinical Governance - Provide a framework that reduces the risk to the organisation

8. Methods of therapy management for HFLN?

9. Patient group direction Supplementary prescribing Independent prescribing www.nes.scot.nhs.uk/pgds

10. Role of the prescriber in Medicines Management Agree a management plan Patient education Manage symptoms Ensure maximum benefit Ensure minimum side effects

11. Accountability of the Prescriber Work within own professional body’s guidance Ensure that they work within their competence Professional Indemnity Audit service provided Risk assessment Continuous Professional Development www.nes.scot.nhs.uk/nursing/prescribing

12. Lanarkshire’s practice to date… Medical therapy guidelines PGDs for diuretic and Beta blockers GP or Cardiologist signature for other changes Development of HFNS

13. Frusemide (diuretics) prescription 2004-05 cost = £203 Bumetanide Bisoprolol (betablockers) prescription 2004-05 cost = £ 1309 Carvedilol Lisinopril (ACE I ) prescription 2004-05 cost = £ 978 Ramipril Candesartan (ARBs) prescription 2004-05 cost = £1008 Losartan Total P.A £3498 Estimated maximum costs for NHSL p.a

14. Lanarkshire DeveIopment Ratification of area policy Communication with key personnel Developing CMP templates and management algorithms Consultation for prescribing budget!!!!!!

16. Challenges for the future… Improving competency Audit of practice Integration of prescribing services Clarity from SEHD National Strategic Framework